To evaluate the efficacy of action learning for improving cancer related pain management in the acute healthcare settings. Despite the prevalent use of action learning in private, public, clinical and non-clinical settings, no studies were found in the literature that either examined cancer pain management or used action learning as an approach to improve patient care in acute healthcare settings.An intervention pre - posttest design was adopted using an action learning programme (ALP) as the intervention. Healthcare professionals knowledge, attitudes and practice were assessed and evaluated before and after the implementation of the six-month ALP. A pre and post audit and survey were conducted for data collection. The data were collected from the entire population of 170 healthcare professionals in one healthcare organisation.The management of cancer related pain improved significantly following the intervention. Significant improvement were also seen in healthcare professionals knowledge, attitudes with improved cancer related pain management as a consequence of this.Despite many organisational challenges to practice development and collaborative working in healthcare settings there is evidence that action learning can achieve positive outcomes for improving CRP and supporting collaborative working. Action learning needs to be considered as a strategy for achieving high quality standards. This article is protected by copyright. All rights reserved.

Dietary nitrate has been shown to increase nitrate/nitrite levels in multiple populations, with potential blood pressure lowering effects. However, there are few reports among hypertensives.We aimed to assess the effect of daily nitrate in subjects with controlled hypertension vs. uncontrolled hypertension.On day 0, hypertensives wore an ambulatory BP monitor (ABPM) for 24h and fasting blood was taken. Subjects then consumed concentrated beetroot juice (12.9mmol nitrate) for 14 consecutive days. On day 14 subjects consumed their last nitrate dose after fasting blood was drawn and again had an ABPM for 24h.According to baseline ABPM, 11 subjects had controlled BP while 8 had uncontrolled BP. There were similar, significant increases in serum nitrate/nitrite in both groups. We observed little change in BP variables among controlled hypertensives. However, there were reductions in BP variables in uncontrolled hypertensives where decreases in nighttime DBP (-64.8mmHg), arterial stiffness (-0.080.03 ambulatory arterial stiffness index) and LDL (-0.360.42mmol/L) reached significance (p=003, 0.05 and 0.046, respectively).Our results support the existing data suggesting an anti-hypertensive effect of nitrate-containing beetroot juice, but only among those with uncontrolled hypertension.

PubMed | Materials Misericordiae University Hospital, Connolly Hospital Blanchardstown, The Adelaide and Meath Hospital, National University of Ireland and 2 more.Type: | Journal: Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association | Year: 2017

Celiac disease is an immune-mediated enteropathy characterized with high heterogeneity in presentation among genetically predisposed individuals. In recent years, a change in the phenotypic presentation of celiac disease has been reported. We studied clinical presentation, from 1960 through 2015, in Ireland, which has a high incidence of celiac disease.We performed a retrospective analysis of medical charts from patients diagnosed with celiac disease at 5 secondary referral centers in Ireland from 1960 through 2015 (n=749; median age, 56 years; age range 18-91 years). The cohort was divided into 5 groups based on year of diagnosis (1985, 1986-1995, 1996-2005, 2006-2010, or 2011 and later). We collected findings from clinical presentation at diagnosis, serology tests and small intestinal biopsy analyses, as well as patients demographic, clinical, and family data. Presentations at diagnosis were classified according to the Oslo criteria as follows: classical (patients presenting with malabsorption), non-classical (no signs or symptoms of malabsorption at presentation), or subclinical (below the threshold of clinical detection). The primary outcome was change in clinical presentation of celiac disease over time.Of the 749 patients studied, 512 were female and 237 were male (ratio of 2.2:1). Female patients were diagnosed at younger ages than male patients (42 vs 47 years respectively, P=.004), and had more immune-mediated conditions than male patients (35.7% for female patients vs 21.5% for male patients, P

Synovial chrondomatosis is a rare disorder characterised by the development of hyaline cartilage from the synovial membrane. Large isolated lesions in the Hoffas fat pad are an uncommon entity.A 33 year old gentleman presented complaining of progressive knee pain associated with an enlarging lesion on the anterior aspect of the right knee, with associated locking and giving way. Examination revealed a firm 45cm lesion adjacent to the patellar tendon. Subsequent CT and MRI demonstrated a lesion in the inferior aspect of Hoffas fat pad, with a second lesion adjacent to the proximal tibiofibular joint, in addition to advanced degenerative changes and a meniscal tear. He proceeded to excisional biopsy. Histological analysis was consistent with a solitary synovial osteochondroma. There were no atypical features suggestive of malignancy.Synovial chondromatosis is a rare disorder affecting the synovial joints. The underlying pathophysiology is thought to be metaplastic change of the synovium to hyaline cartilaginous tissue. Transformation to malignancy has been described but is uncommon with an estimated risk of 5%. It is 1.5-2 times as prevalent in males versus females. Symptoms which patients may complain of include pain;locking and giving way; and palpable masses. The management usually entails removal of the mass lesion with or without accompanying synovectomy. Recurrence of disease may occur in up to 15-23% of patients.Synovial chrondromatosis is a rare but well recognised condition. Long term follow up is advised in view of the risk of recurrence and malignant transformation.